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Managed Long Term Services and Supports Nurse Specialist RN II

North American Staffing Group
Los Angeles, CA
  • Expired: over a month ago. Applications are no longer accepted.
Job Description
Medica Talent Group is excited to share this Direct Hire opportunity with our client who is a reputable health plan that serves more than 2 million members providing quality healthcare to the most vulnerable and low-income populations. If you are seeking a fulfilling role with an organization that values its members and have experience working as a Case Management RN we eagerly invite you to apply!
The Managed Long-Term Services and Supports (MLTSS) Nurse Specialist RN II applies advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for all members. Utilizes assessments, member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available Health Plan, Home and Community Based Services (HCBS), and MLTSS resources, optimal member functioning, and cost-effective outcomes.
Collaborate with Skilled Nursing Facilities (SNF), Community Based Adult Services (CBAS) Centers, Preferred Provider Groups (PPG), Care Management and Social Services to facilitate authorization of services. Coordinate the identification, documentation, and resolution of related issues in a timely manner.
  1. Responsible for performing assessments of members referred to MLTSS programs for the identification, evaluation, coordination, and management of members' needs, including physical health, behavioral health, social services, and MLTSS.
  2. Provides direction to non-clinicians who assist members with accessing services. Conducts additional assessments as necessary, to monitor, evaluate and revise members' care plans to meet members' needs, with the goal of optimizing member health care across the care continuum. Arranges for all services required while coordinating with the health care team to eliminate duplication of services.
  3. Interfaces with Medical Directors, social workers, and interdisciplinary care team (ICT). Participates in ICT meetings and makes recommendations for MLTSS programs.
  4. Establishes relationships with referral sources and community resources, such as external providers, SNFs, CBAS Centers, PPGs, and care coordinators, while maintaining strict member confidentiality and complying with all Health Insurance Portability and Accountability Act (HIPAA) requirements.
  5. Facilitates care coordination with internal and external entities to improve member's short and long term goals in collaboration with member, caregivers, family, support systems, and physicians. A person-centered approach will minimize member confusion, and ensure that the best care is delivered in the most appropriate setting.
  6. Performs clinical review of SNF and CBAS services and determines if the request is appropriate level of care. Evaluates if needs can be addressed through other avenues, such as, community services, HCBS and covered health plan benefits, and makes referrals to appropriate programs.
  7. Documents accurately and comprehensively based on the standards of practice and current organization policies.
  8. Performs other duties as assigned.
Education Required
Associate's Degree in Nursing
Education Preferred
Bachelor's Degree in Nursing
Experience Required:
  1. At least 5-7 years of clinical nursing experience in direct patient care, such as ambulatory care, home care, or case management. OR experience in Utilization Review or Care Management will be considered in lieu of direct patient care. 3 years of relevant Licensed Vocational Nurse (LVN) experience may be substituted for 2 years of RN experience.
  2. Clinical experience working with individuals with chronic illnesses, comorbidities, and/or disabilities in a case/care management environment.
Experience in utilization review, skilled nursing, home health, discharge planning, behavioral health, community resources, and/or other home and community-based agencies.
Skills Required:
Excellent verbal and written communication skills.
Excellent organizational and time-management skills.
Proficient in Microsoft Office.
Licenses/Certifications Required:
Registered Nurse (RN) - Active, current and unrestricted California License

North American Staffing Group


Los Angeles, CA